[The anticonvulsive effect of 4,4-bis(hydroxymethyl)-2-phenyl-2-oxazoline]. / Efecto anticonvulsionante de la 2-fenil-4,4-bis (hidroximetil)-2-oxazolina.

INTRODUCTION: Certain compounds belonging to the family of the 2-aryl oxazolines have been reported to act on the central nervous system with a number of different effects and applications, which make them useful as depressants, anaesthetics, anticonvulsants, and so on. AIMS: Our aim was to study the possible effect of 4,4-bis(hydroxymethyl)-2-phenyl-2-oxazoline (OX), obtained by chemical synthesis using microwaves, in two experimental models of epilepsy. MATERIALS AND METHODS: Two models were used: one involving (repeated stimulation) electroconvulsive shock in mice and the other consisted in inducing audiogenic seizures in Mongolian gerbils. Recordings were performed of the potentials in the dentate gyrus (DG) generated in response to electrical stimulation of the entorhinal cortex in anaesthetised gerbils, using the stereotactic technique. RESULTS: A 150 mg/kg dose of OX lowered the number of electrical pulses required to induce the tonic seizures triggered by the electroshock, as well as their duration. This same dose blocked the seizures induced by audiogenic stimuli in the gerbils and significantly reduced their severity (degrees of seizures) and occurrence. OX diminished, in a dose-dependent manner, the amplitude of the excitatory post-synaptic potential and that of the population spike, triggered by stimulating the entorhinal cortex in the DG. CONCLUSIONS: OX acts as an antiepileptic agent and its mechanism of action could be related to the inhibiting effect it exerts on the entorhinal cortex-DG synapses in the hippocampus.

Efecto anticonvulsionante de la 2-fenil-4, 4-bis (hidroximetil)-2-oxazolina / The anticonvulsive efecto of 4, 4-Bis (Hydroxymethyl)-2-phenyl-2oxazoline

Introduction. Certain compounds belonging to the family of the 2-aryl oxazolines have been reported to act on the central nervous system with a number of different effects and applications, which make them useful as depressants, anaesthetics, anticonvulsants, and so on. Aims. Our aim was to study the possible effect of 4,4-bis(hydroxymethyl)-2-phenyl-2-oxazoline (OX), obtained by chemical synthesis using microwaves, in two experimental models of epilepsy. Materials and methods. Two models were used: one involving (repeated stimulation) electroconvulsive shock in mice and the other consisted in inducing audiogenic seizures in Mongolian gerbils. Recordings were performed of the potentials in the dentate gyrus (DG) generated in response to electrical stimulation of the entorhinal cortex in anaesthetised gerbils, using the stereotactic technique. Results. A 150 mg/kg dose of OX lowered the number of electrical pulses required to induce the tonic seizures triggered by the electroshock, as well as their duration. This same dose blocked the seizures induced by audiogenic stimuli in the gerbils and significantly reduced their severity (degrees of seizures) and occurrence. OX diminished, in a dose-dependent manner, the amplitude of the excitatory post-synaptic potential and that of the population spike, triggered by stimulating the entorhinal cortex in the DG. Conclusions. OX acts as an antiepileptic agent and its mechanism of action could be related to the inhibiting effect it exerts on the entorhinal cortex-DG synapses in the hippocampus (AU)

Introducción. Algunos compuestos de la familia de las 2- aril-oxazolinas se han descrito como sustancias activas sobre el sistema nervioso central, con efectos y aplicaciones diversas, como depresores, anestésicos, anticonvulsionantes, etc. Objetivo. Estudiar el posible efecto de la 2-fenil-4,4-bis (hidroximetil)-2-oxazolina (OX) obtenida por síntesis química bajo microondas en dos modelos de epilepsia experimental. Materiales y métodos. Se emplearon el modelo de choque electroconvulsivo –por estimulación repetitiva– en ratones y el de crisis audiogénica en el gerbo mongol. Se incluyó el registro de los potenciales del giro dentado (GD) en respuesta a la estimulación eléctrica de la corteza entorrinal en el gerbo anestesiado mediante la técnica estereotáctica. Resultados. La dosis de 150 mg/kg de OX redujo el número de pulsos eléctricos necesarios para inducir la crisis tónica producida por el choque eléctrico, así como su duración. Esta misma dosis bloqueó las crisis inducidas por el estímulo audiogénico en el gerbo y disminuyó significativamente su gravedad (grados de crisis) y aparición. La OX redujo, en forma dependiente de la dosis, la amplitud del potencial postsináptico excitatorio y de la espiga de población, provocada por la estimulación de la corteza entorrinal en el GD. Conclusiones. La OX posee un efecto antiepiléptico cuyo mecanismo podría estar relacionado con su acción inhibitoria sobre la sinapsis corteza entorrinal-GD en el hipocampo (AU)

PCR detection of potentially pathogenic aeromonads in raw and cold-smoked freshwater fish.

AIMS: Development of a PCR assay for detection of aeromonads carrying the hlyA and/or aerA genes in fish. METHODS AND RESULTS: The protocol involves an overnight selective enrichment step in tryptic soy broth yeast extract containing 10 microg ml(-1) of ampicillin followed by extraction of DNA and PCR amplification of two haemolysin genes that contribute to the virulence of Aer. hydrophila. This procedure can detect initial populations of 1-10 cfu g(-1) within 24 h in artificially contaminated samples. In naturally contaminated fish, both genes were detected in 13 out of 14 fresh fish lots (aeromonads levels between < 1 and 5.42 log cfu g(-1)) and in 4 out of 16 lots of vacuum-packed cold-smoked fish (aeromonads levels between < 1 and 3.37 log cfu g(-1)). Before enrichment, dominant species were Aer. hydrophila HG1 (aerA+hlyA+), Aer. bestiarum HG2 (aerA+hlyA+) and Aer. caviae HG4 (aerA-hlyA-). After enrichment, Aer. hydrophila HG1 (aerA+hlyA+) was dominant. CONCLUSIONS: Fresh fish and even smoked fish carry hlyA+ and/or aerA+ aeromonads that can be detected by PCR within 24 h. SIGNIFICANCE AND IMPACT OF THE STUDY: The PCR assay described offers considerable potential as a rapid method with specificity, sensitivity and simplicity.

Foodborne pathogenic bacteria in prepackaged fresh retail portions of farmed rainbow trout and salmon stored at 3 degrees C.

Twelve lots of fresh unskinned fillets of rainbow trout (Oncorhynchus mykiss) and 10 lots of fresh sliced salmon (Salmo salar) prepacked in trays wrapped with an oxygen-permeable film were obtained immediately after packing from two supermarkets having in-plant facilities for packaging wet fish. During storage at 3 degrees C, Listeria innocua was detected in eight lots of trout fillets after 4 days storage. L. monocytogenes was recovered from a single lot also contaminated with L. innocua. Initial numbers of aeromonads were significantly (p < 0.05) lower in trout fillets (3.35 +/- 0.62 log cfu g(-1)) than in salmon slices (4.20 +/- 0.89 log cfu g(-1)). In both fish products, these bacteria significantly (p < 0.05) increased up until spoilage. Most Aeromonas spp. isolates from trout fillets were assigned to A. veronii biovar sobria HG8 (hybridisation group 8), A. caviae HG4, A. eucrenophila HG6, A. hydrophila HG1 and A. veronii biovar veronii HG10. Strains of HG12 (A. schubertii), HG4 and HG8 formed the majority of aeromonads recovered from salmon slices.

Bacteriological quality of aquacultured freshwater fish portions in prepackaged trays stored at 3 degrees C.

Fresh trout fillets and salmon slices packed in trays were obtained from two multinational chain supermarkets and evaluated for freshness and bacteriological quality immediately after packaging and during storage at 3 degrees C. Initial aerobic counts at 30 and 25 degrees C were significantly (P < 0.05) lower in trout fillets (5.27 +/- 0.57 and 4.87 +/- 0.80 log CFU/g, respectively) than in salmon slices, where levels in excess of 6 log CFU/g were found. In both products, initial Enterobacteriaceae counts were slightly higher than 3 log CFU/g and increased significantly during shelf life by approximately 3 log CFU/g. Most of the enterobacteria were identified as Citrobacter freundii, Hafnia alvei, and Enterobacter cloacae. On day 0, most probable number (MPN) counts of total and fecal coliforms were not significantly different, numbers of the latter group being approximately 4 MPN/g. Escherichia coli was only detected when fish was spoiled. Although initial presumptive Staphylococcus aureus counts were approximately 3 log CFU/g, only 4 of 84 selected colonies belonged to this species. Neither Salmonella nor antimicrobial residues were detected in any sample. Ethanol content in salmon slices did not significantly (P > 0.05) increase until they became inedible. Significant correlation (r = +0.72, P < 0.05) was observed between this chemical index and viable counts at 30 degrees C only when salmon slices were inedible. Trout fillets were acceptable for 7 days, and salmon slices showed signs of spoilage after 4 days. Although public health concerns associated with packed trout and salmon appear to be minimal, data on sensory quality, shelf life, and total viable and Enterobacteriaceae counts strongly suggest the need to improve the quality control systems used by European multinational retailers, especially for imported salmon.

Smoking in Colombian medical schools: the hidden curriculum.

BACKGROUND: Tobacco companies are focusing their interest in less developed countries. In the absence of governmental opposition, physicians are expected to lead tobacco control efforts. We studied Colombian medical students' smoking prevalence and tobacco attitudes. METHODS: First- and fifth-year students from 11 medical schools in seven Colombian cities answered anonymous, self-administered, 38-item questionnaires. Additionally, smokers answered the Fagerström Test for Nicotine Dependence (FTND). RESULTS: Two thousand twenty-one students (males 50.6%; age 15-44, median 19) completed the survey; average response rate was 89.9%. Globally 25.9% of students were current smokers (males 27.9%, females 24.0%). Living at higher altitude and attending private universities were associated with higher prevalence (P < 0.001). Males had a higher chance of having given up smoking (P < 0.05); 91.3% of current smokers would like to quit; 67.3% of all smokers and 44.8% of daily smokers scored 0 in the FTND. Prevalence was similar among first- and fifth-years, but fifth-year students were more complacent with smoking in health centers and showed a lesser desire to quit. CONCLUSIONS: Medical students' smoking prevalence is similar to that of the general population. Tobacco control strategies need to be included in the curriculum. Nicotine addiction does not seem to be the main perpetuating factor.

Hepatitis B postrasplante hematopoyético autólogo. Descripción de un caso de seroconversión inversa / No disponible

No disponible

APOE epsilon4 and Alzheimer's disease: positive association in a Colombian clinical series and review of the Latin-American studies.

OBJECTIVE: As the strength of the association between the APOE epsilon4 allele and Alzheimer's disease (AD) varies across ethnic groups, we studied if there was such an association in Colombian patients. METHOD: We performed apolipoprotein E (APOE) genotyping in a clinical sample of 83 unrelated AD patients, predominantly late-onset (>65 yrs) including familial ( n =30) and sporadic AD cases (n= 53) diagnosed according to NINCDS-ADRDA criteria and assessed by a multi-disciplinary team. Control subjects (n = 44) had no significant cognitive impairment by medical interview and neuro-psychological testing. RESULTS: We found a high association (OR= 5.1 95%CI 1.9 -13.6) between APOE epsilon4 and AD, in this series with predominantly late-onset cases with familial aggregation in 24 cases (28.9%). A significant negative association was found between epsilon2 and AD (OR= 0.2 95% CI 0.05-0.75). CONCLUSION: Further population-based surveys in Colombia are warranted to precise a possible dose effect of APOE epsilon4.

Enemas during labor.

BACKGROUND: The use of enemas during labor usually depends on the preference of the attending physician and available resources. However enemas cause discomfort in women and increase the costs of delivery. OBJECTIVES: The objective of this review was to assess the effects of enemas during the first stage of labor on infection rates in mothers and newborns, duration of labor, perineal wound dehiscence in the mother, perineal pain, faecal soiling and costs. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness, Medline and reference lists of articles. SELECTION CRITERIA: Randomised trials in which an enema was administered during the first stage of labor and which included assessment of possible neonatal or puerperal morbidity or mortality. DATA COLLECTION AND ANALYSIS: Selected studies were assessed by three reviewers independently. MAIN RESULTS: Two trials involving 665 women were included. These showed no clear difference in infection rates for puerperal mothers (odds ratio 0.61, 95% confidence interval 0.36 to 1.04) or newborn children. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of routine enemas during the first stage of labor.

[The evaluation of gastrointestinal tolerance for a new infant feeding formula (Similac) in healthy infants]. / Evaluación de la tolerancia gastrointestinal de una nueva fórmula de alimentación infantil (Similac) en niños sanos.

There is a pediatric consensus that maternal milk is the best food for the new born, but when this is impossible, one turns to artificial nutrition. The main objective of infant formulae is to achieve a gastrointestinal tolerance that is similar to maternal milk. With this in mind, we carried out an observational, prospective, and multicentric study with the objective of evaluating the gastrointestinal tolerance of Similac, taking maternal milk and other formulae on the market as reference. The study included 2 pediatric visits, a diary in which the parents recorded the gastrointestinal parameters, and a final questionnaire to evaluate the degree of satisfaction. Information was obtained from 6,617 evaluable cases, 82.2% fed with Similac (S), 8.8% with maternal milk (MM) and 9% with other formulae (OF). The analysis of the data showed that the percentage of children with signs of gastrointestinal intolerance, was reduced to more than half when using S compared to OF (5.6% S, 5% LM, and 14.1% OF). The color and consistency of the feces was significantly associated with the formula group, and in both cases S showed a greater similarity to the pattern obtained with MM compared to the OF group. 18.6% of the children with OF presented hard feces, and this percentage was reduced to at least half with S (6.2%). The S group showed a greater percentage of lack of regurgitations and no aerophagia and the lowest percentage for three or more regurgitations and severe aerophagia. Those questioned considered that S was easier to reconstitute up, is liked better, and is better tolerated than the OF used. Similac achieved a greater similarity in gastrointestinal tolerance to that of maternal milk than other formulae did.

[Neurology and the reform of the health care system in Colombia]. / Neurología y reforma del sistema de salud en Colombia.

INTRODUCTION AND OBJECTIVES: Despite the magnitude of the Colombian health system reform, introduced in 1993, changes in specialized medical practice have not been evaluated. This paper is the follow-up of a similar study on the practice of neurology done by the authors before the reform. MATERIAL AND METHODS: Of the 62 members of the Colombian Association of Neurology living in Bogotá, 47 (76%) of them responded an anonymous survey inquiring on the characteristics of their medical practice and registering all the medical encounters during one week in October 1998. RESULTS: Two thirds of the total working time is devoted by neurologists to clinical work. Half of the neurologists in the sample have invested in diagnostic equipment. There was no significant change in the total number of patients attended during the week, as compared with the 1993 study, and the diagnostic profile was similar. The proportion of private patients was significantly lower, while patients from prepaid medical schemes increased. Patients belonging to the Obligatory Health Plan, designed to cover lowest income population, and to prepaid medicine are not distributed homogeneously throughout all ages. The first year of life is particularly uncovered by the Obligatory Health Plan, while prepaid schemes do not address the problems of individuals age 60 or more. CONCLUSIONS: There has been a significant reduction in private practice compensated by an increase in prepaid medicine. There is no evidence of increased coverage for neurological disorders.

Neurología y reforma del sistema de salud en Colombia / Neurology and reform of the healthcare system in Colombia

Introducción y objetivos. La reforma del sistema de salud en Colombia, iniciada en 1993, introdujo importantes cambios cuyos efectos sobre el ejercicio médico no se han evaluado. En este trabajo se recoge el seguimiento de un análisis de la práctica neurológica realizado por los autores antes de la proclamación de la reforma. Material y métodos. De los 62 neurólogos afiliados a la Asociación Colombiana de Neurología y residentes en Bogotá, 47 de ellos (76 por ciento) aceptaron participar en el estudio. Estos neurólogos respondieron preguntas sobre el perfil de su ejercicio profesional y llevaron un registro de pacientes atendidos durante una semana. Resultados. De su tiempo laboral total, los neurólogos dedican dos terceras partes al trabajo clínico. La mitad de ellos complementan sus ingresos con la inversión en equipos de diagnóstico neurológico. Con respecto al estudio anterior, realizado en 1993, no encontramos variación significativa en el número de consultas practicadas ni en los tipos de diagnósticos en los pacientes atendidos. Evidenciamos una disminución significativa en la proporción de enfermos particulares y un aumento en la de pacientes de medicina prepagada. Los pacientes afiliados tanto al Plan Obligatorio de Salud (POS) como a la medicina prepagada no se distribuyen de manera homogénea en todos los grupos etáreos. Hace falta afiliación al POS en el primer año de vida, mientras que en la tercera edad es menor la proporción de pacientes en los sistemas prepagados. Conclusiones. El cambio más significativo es la reducción en los pacientes privados, compensado con un incremento de la medicina prepagada. No se observan cambios compatibles con una mayor cobertura del sistema (AU)

Evaluation of institutional cancer registries in Colombia.

The four primary objectives of this descriptive study were to: 1) design a quality-measurement instrument for institutional cancer registries (ICRs), 2) evaluate the existing ICRs in Colombia with the designed instrument, 3) categorize the different registries according to their quality and prioritize efforts that will efficiently promote better registries with the limited resources available, and 4) determine the institution with the greatest likelihood of successfully establishing Colombia's second population-based cancer registry. In 1990 the National Cancer Institute of Colombia developed 13 institution-based cancer registries in different Colombian cities in order to promote the collection of data from a large group of cancer diagnostic and treatment centers. During the first half of 1997, this evaluation reviewed 12 registries; one of the original 13 no longer existed. All of the Colombian institutions (hospitals) that maintain institution-based cancer registries were included in the study. At each institution, a brief survey was administered to the hospital director, the registry coordinator, and the registrar (data manager). Researchers investigated the institutions by looking at six domains that are in standard use internationally. Within each domain, questions were developed and selected through the Delphi method. Each domain and each question were assigned weights through a consensus process. In most cases, two interviewers went to each site to collect the information. The university hospitals in Cali, Pereira, and Medellín had substantially higher scores, reflecting a good level of performance. Four of the 12 institutions had almost no cancer registry work going on. Five of the 12 hospital directors considered that the information provided by the cancer registries influenced their administrative decisions. Three of the registries had patient survival data. Four of the institutions allocated specific resources to operate their cancer registries; in the other 8 hospitals there was no clear budget allocation. Seven of the hospital directors could not identify five or more objectives of a cancer registry. Data management was usually poor and resources insufficient at most of the institutions. In summary, the cancer registry system in Colombia varies greatly from institution to institution. A few of the hospitals do a good job while others have neglected the registries. The high, identical total scores for Pereira and Medellín suggest they would be good locations to establish new population-based cancer registries similar to the existing one in Cali. However, the overall characteristics in Pereira may provide a more appropriate environment for the second registry, with Medellín as an alternative.

Prescription patterns of recently graduated physicians in Colombia: a survey during the mandatory social work period.

MAIN OBJECTIVE: To quantify prescribing patterns of physicians during their year of social work in health centers of Bogotá, Colombia, for three tracer conditions: acute respiratory infection (ARI), systemic hypertension (SH) and acute diarrhea (AD). DESIGN: Cross-sectional survey. SETTING: Primary Care Health Centers in the city of Bogotá. STRATEGY: The Health District Department of Bogotá (Secretaria Distrital de Salud) provided the sampling frame of SILOS (Local Health System) and UPAS (primary health service units) with a physician in the social work year. Samples of patient-physician encounters for the three tracer conditions within UPAS were examined, and detailed information collected on prescription indicators. RESULTS: Information was collected on a total of 1099 patient-physician encounters. Results show that 61% (95% CI: 58.6-63.1) of prescriptions in these settings are non-generic, and only 62% (95% CI: 59.5-64.0) are from the Colombian essential drug list. Number of medications prescribed per encounter were higher with ARI, as well as prescriptions for non-generic forms, antibiotics, and medications outside of the Colombian essential drug list. Inappropriate prescriptions were seen in 31% (95% CI: 28.1-33.7) of all encounters. DISCUSSION: Inadequacy of prescriptions (based on diagnosis) suggest that the teaching of rational prescribing patterns should be targeted with much more emphasis in schools of medicine. Interventions focused on the outstanding deficiencies should be designed and properly evaluated.

Acrodermatitis continua de Hallopean / Continued acrodermatitis of Allopean

Se publican 4 casos de Acrodermatitis continua de Hallopeau, algunos de ellos seguidos durante mas de 20 anos. Consideramos que la imagen histopatologica (pustula espongiforme) no autoriza a incluirla dentro de la psoriasis ya que son mas los puntos que la separan que los que las unen. Ellos son: manifestaciones cutaneas dolorosas, antecedentes traumaticos locales como desencadenantes, compromiso casi exclusivo de la extremidad distal del pulgar dejando en brotes sucesivos atrofia cutanea y esclerosis de tejidos blandos, afectacion temprana de la una que puede conducir a la perdida de la lamina ungueal, respeto por la region central de palmas y plantas, compromiso oseo hasta severa mutilacion. No presenta lesiones tipicas de psoriasis vulgar en otros sitios, ni antecedentesfamiliares de ella ni HLA,B13,B17 y BW37

Acrodermatitis continua de Hallopean / Continued acrodermatitis of Allopean

Se publican 4 casos de Acrodermatitis continua de Hallopeau, algunos de ellos seguidos durante mas de 20 anos. Consideramos que la imagen histopatologica (pustula espongiforme) no autoriza a incluirla dentro de la psoriasis ya que son mas los puntos que la separan que los que las unen. Ellos son: manifestaciones cutaneas dolorosas, antecedentes traumaticos locales como desencadenantes, compromiso casi exclusivo de la extremidad distal del pulgar dejando en brotes sucesivos atrofia cutanea y esclerosis de tejidos blandos, afectacion temprana de la una que puede conducir a la perdida de la lamina ungueal, respeto por la region central de palmas y plantas, compromiso oseo hasta severa mutilacion. No presenta lesiones tipicas de psoriasis vulgar en otros sitios, ni antecedentesfamiliares de ella ni HLA,B13,B17 y BW37

Leucemia de células vellosas: complicación dermatológica / Hairy-cell leukaemia: dermatologic complication

Se comunica un paciente de 49 años, sexo masculino, con lesión erosiva impetiginizada en región pubiana y ulceración no infiltrada en prepucio. Masa ganglionar inguinal derecha flegmásica de 15 x 5 x 2,5 cm. Micropoliadenopatías inguinales izquierdas y adenopatía asintomática axilar derecha. Hepatoesplenomegalia. Astenia, Pancitopenia. Los estudios realizados ratificaron el diagnóstico de L. C. V., cuya frecuencia es del 2% en el total de las leucemias del adulto. La C. V. tiene su origen en una célula linfoide B y se sitúa en el sistema de diferenciación en un estadio algo más evolucionado que la de la leucemia linfática crónica. Se caracteriza por tener citoplasma extenso dotado de típicas prolongaciones o pelos. La maior parte del cuadro clínicos es consecuencia de la pancitopenia y la explenomegalia. las lesiones dermatológicas asociadas más frecuentemente son las inespecíficas, y se expresan por infecciones recurrentes, equimosis o las resultantes de vasculitis. Las específicas se observan en un 8% de los casos y se traducen por erupciones máculo-pápulo eritematosas. predomina en el sexo masculino, pero el pronóstico es mejor en el femenino. Los tratamientos instituídos segun la sintomatología y curso evolutivo son la esplenectomía, el alfa Interferón, y 2 - Deoxycoformicina (AU)

Leucemia de células vellosas: complicación dermatológica / Hairy-cell leukaemia: dermatologic complication

Se comunica un paciente de 49 años, sexo masculino, con lesión erosiva impetiginizada en región pubiana y ulceración no infiltrada en prepucio. Masa ganglionar inguinal derecha flegmásica de 15 x 5 x 2,5 cm. Micropoliadenopatías inguinales izquierdas y adenopatía asintomática axilar derecha. Hepatoesplenomegalia. Astenia, Pancitopenia. Los estudios realizados ratificaron el diagnóstico de L. C. V., cuya frecuencia es del 2% en el total de las leucemias del adulto. La C. V. tiene su origen en una célula linfoide B y se sitúa en el sistema de diferenciación en un estadio algo más evolucionado que la de la leucemia linfática crónica. Se caracteriza por tener citoplasma extenso dotado de típicas prolongaciones o pelos. La maior parte del cuadro clínicos es consecuencia de la pancitopenia y la explenomegalia. las lesiones dermatológicas asociadas más frecuentemente son las inespecíficas, y se expresan por infecciones recurrentes, equimosis o las resultantes de vasculitis. Las específicas se observan en un 8% de los casos y se traducen por erupciones máculo-pápulo eritematosas. predomina en el sexo masculino, pero el pronóstico es mejor en el femenino. Los tratamientos instituídos segun la sintomatología y curso evolutivo son la esplenectomía, el alfa Interferón, y 2 - Deoxycoformicina